Intraocular Pressure, Axial Length, and Refractive Changes after Phacoemulsification and Trabeculectomy for Open-Angle Glaucoma

Abstract

Purpose To compare changes in intraocular pressure (IOP), axial eye length (AEL), and refractive outcome in primary open-angle glaucoma patients undergoing cataract surgery and trabeculectomy in dependence of the sequence of surgeries. Materials and Methods We retrospectively analysed 48 eyes. The changes in refraction, intraocular pressure, and axial eye length were analysed after surgery. In group A (21 subjects), phacoemulsification was performed before trabeculectomy, and in group B (27 subjects), trabeculectomy was performed before phacoemulsification with a minimum time span between interventions of 6 months. Results The reduction in IOP and the decrease in AEL after trabeculectomy were significant after 6 and 12 months postsurgery (p < 0.001 each). The decrease in AEL was 0.42 ± 0.11% at 6 months after surgery and 0.40 ± 0.13% after 12 months from surgery; this decrease in AEL was comparable between the groups. The refractive outcome was significantly different between the groups (group A: 0.35 ± 0.75 dpt, group B: −0.05 ± 0.36 dpt, p = 0.018); in group A, trabeculectomy caused a hyperopic shift of 0.34 ± 0.44 dpt (p = 0.002) at 12 months postsurgery. Conclusion IOP reduction after trabeculectomy causes AEL shortening. The effect on refractive outcome depends on the sequence of surgeries. Better refractive outcome is achieved if phacoemulsification is performed after trabeculectomy.

Prospective cohort study of risk factors for choroidal detachment after trabeculectomy

“…In fact, multivariate analysis has shown that greater DIOP rather than lower postoperative IOP is a significant prognostic factor for choroidal detachment, suggesting that the gap between pre-and postoperative IOPs increases the occurrence of choroidal detachment rather than postoperative hypotony, which may be explained by the change in ocular shape. Several reports have shown that IOP reduction causes axial length shortening after trabeculectomy [11][12][13][14][15]. The structural change in eyeball shape due to greater DIOP might have increased fluid inflow into the suprachoroidal space.…”

Significant hyperopic shift in a patient with extreme myopia following severe hypotonia caused by glaucoma filtering surgery

“…Also, there are various reports describing IOP reduction after trabeculectomy that may cause AL shortening. 9,10 However, there are no reports concerning the effects on the ocular biometrics after glaucoma filtering surgery with a mini shunt device.…”

Effect of Anti-glaucoma Agents on Myopic Retinoschisis

“…Previous studies have shown that axial length decreases when trabeculectomy is performed in patients with high myopia [10][11][12][13], and animal studies have also reported that axial length decreases when intraocular pressure (IOP) is lowered [14][15][16]. Another study revealed that IOP and increased axial length affected the progression of myopic retinoschisis [17].…”